Article excerpt

Contrary to the expectations of many mental-health clinicians, a large-scale study finds that severe depression in patients with bipolar disorder responds no better to a combination of antidepressant medications and mood-stabilizing drugs than it does to mood stabilizers alone.

In another challenge to clinical lore, the federally funded investigation indicates that antidepressant use doesn't hasten the emergence of manic symptoms, such as grandiose thinking and euphoric feelings, in patients with bipolar disorder.

Mild-to-severe versions of bipolar disorder afflict nearly 4 percent of adults at some time in their lives. The illness features swings between periods of depression and mania. Treatment typically includes mood stabilizers such as lithium or other mania-reducing drugs. Clinicians often treat bipolar depression with antidepressants as well, although they have worried that these substances may chemically jolt patients from depression into mania.

Antidepressants are safe to use with mood stabilizers but ease bipolar depression no better than placebo pills do, report psychiatrist Gary S. Sachs of Massachusetts General Hospital in Boston and his colleagues. Their investigation, the largest ever of bipolar disorder, appears online and in the April 26 New England Journal of Medicine.

The researchers studied 366 volunteers diagnosed with bipolar disorder at any of 22 psychiatric centers in the united States. Participants included individuals with severe and moderate forms of mania. Many had also experienced other mental ailments, such as anxiety disorders, substance abuse, and psychosis.

At the start of the study, the volunteers exhibited only symptoms of depression. Physicians first made sure that each patient was taking an appropriate dose of a mood-stabilizing drug. …

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